Thursday, December 18, 2008

Employee Medical Testing Authorization Letter


I, [Name] of [insert address] of legal age. Hereby grant permission for the following medical test to be performed on my body:

CBC Blood, Urine Sample
Chest X-ray

I further acknowledge that such tests may involve the temporary invasion or penetration of my body by medical instruments, light, sound, x-rays, or other imaging and diagnostic media, and may further involve the obtaining of bodily fluids, tissue, products or waste, all of which I give up any claim to.

I further certify that all such medical procedures have been thoroughly explained to me and that I have provided complete and honest responses to all questions posed to me regarding my health, including pregnancy, disabilities, allergies, and susceptibilities, if any.

I understand that these medical tests are not being performed for my benefit, but are instead performed for the benefit of [insert company or organization] which I hereby release from any and all responsibility for treatment, advice, referral, or diagnosis.

I grant this authorization in exchange for the opportunity to be considered for employment, or for promotion in employment, and I acknowledge such testing is necessary and relevant to my employment.

I voluntarily make this grant without reservation.


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